Long-term spectrum and outcomes of post-transplant malignancy following liver transplantation: A comprehensive...

Malignancy is a leading cause of mortality after liver transplantation (LT), yet its long-term incidence and outcomes remain incompletely defined.

We performed a retrospective single-center cohort study of 1841 adult LT recipients transplanted between 1990 and 2025 to characterize the spectrum, and outcomes post-transplant malignancy. Competing-risk methods accounting for non-cancer mortality were used to estimate cumulative incidence, and Fine-Gray regression identified independent predictors.

Over a median follow-up of 10.6 years, the 25-year cumulative incidence of non-hepatocellular carcinoma (HCC) solid organ malignancy was 18%, while skin malignancy occurred in 29% of recipients. Post-transplant lymphoproliferative disorder developed in 4%, non-PTLD hematologic malignancies in 1%, and post-transplant or recurrent HCC in 18%. Malignancy related mortality accounted for 20% of deaths, second only to infection (23%). Lung, prostate, head and neck, colorectal, and renal cell carcinomas were the most common solid organ malignancies. Increasing age at transplantation independently increased solid organ malignancy risk (hazard ratio 1.22 per decade), while female sex was protective. Survival after malignancy varied substantially by cancer type, with particularly poor outcomes following solid organ malignancy and post-transplant HCC.

ost-transplant malignancy represents a substantial and enduring burden after LT and is a major contributor to late mortality. These findings support the need for lifelong, risk-adapted cancer surveillance strategies tailored to individual patient risk.